肝移植后胆道狭窄的内镜治疗的实用方法
Alex Bofill1, Andrés Cárdenas2
1GI Unit, Institut de Malalties Digestives, Hospital Clinic, Barcelona, Spain.
Annals of hepatology
|November 30, 2023
概括
胆道狭窄在肝移植 (LT) 后很常见. 带着支架的内镜逆行胆血管细胞造影 (ERCP) 是这些并发症的首选治疗方法,提供了良好的结果.
科学领域:
- 肝胆道手术是肝胆道的手术.
- 移植手术 移植手术 移植手术
- 胃肠病学 胃肠病学
背景情况:
- 胆道并发症发生在5-25%的肝移植 (LT) 患者中,显著影响发病率和死亡率.
- 胆道狭窄,特别是解剖胆道狭窄 (ABS),是LT后最常见的胆道并发症.
- 手术技术和供体因素是LT后胆道狭窄的关键风险因素.
研究的目的:
- 为提供关于肝移植后胆道狭窄的管理的最新审查.
- 专注于目前关于后LT胆道狭窄的内镜治疗方法的证据.
主要方法:
- 磁共振胆血管细胞造影 (MRCP) 是LT后胆道狭窄的黄金标准的非侵入性诊断工具.
- 内镜逆行胆血管细胞造影 (ERCP) 是被诊断为胆道狭窄的主要治疗干预措施.
- 治疗策略包括以气球扩张和多重塑料支架 (MPS) 或完全覆盖的金属支架 (FCSEMS) 的胆管缩切除术.
主要成果:
- 经过LT后的胆道收缩,ERCP显示了有利的短期和长期治疗结果.
- 完全覆盖的金属支架 (FCSEMS) 与多重塑料支架 (MPS) 相比,具有潜在的优势,包括减少支架的持续时间和更少的程序.
- 在MPS和FCSEMS之间做出选择取决于个体患者的因素和临床背景.
结论:
- 肝移植后胆道狭窄仍然是一个重大挑战,需要有效的管理策略.
- 内镜治疗,特别是ERCP,对于治疗LT后胆道收缩至关重要.
- 目前正在进行的研究和临床实践正在完善内镜技术和支架选择,以获得最佳的患者结果.
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